Common use of Address Information Clause in Contracts

Address Information. For individual subscribers this address should be the Purchaser’s primary legal residence. For entities other than individual subscribers, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. Legal Address Legal Address City, State, and Zip Code City, State, and Zip Code AGREED AND SUBSCRIBED ACCEPTED This ___ day of _________, 2018 This ___ day of _______, 2018 By: By: Name: Name: Title (if any): Title: Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I______________________ am the ___________________________ of ___________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Subscription Agreement and to purchase and hold the Notes and Shares, and certify further that the Subscription Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.

Address Information. For individual subscribers this address should be the PurchaserSubscriber’s primary legal residence. For entities other than individual subscribers, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. Legal Address Legal Address City, State, and Zip Code City, State, and Zip Code AGREED AND SUBSCRIBED ACCEPTED This ___ day of _________, 2018 This ___ day of _______, 2018 By: By: Name: Name: Xxxxxx Xxxxxxx Title (if any): Title: Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I______________________ am the ___________________________ of ___________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Subscription Securities Purchase Agreement and to purchase and hold the Notes and SharesWarrants, and certify further that the Subscription Securities Purchase Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.

Address Information. For individual subscribers this address should be the Purchaser’s primary legal residence. For entities other than an individual subscribersPurchaser, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. Legal Address Legal Address City, State, and Zip Code City, State, and Zip Code AGREED AND SUBSCRIBED ACCEPTED AGREED AND ACCEPTED This ___ day of _________, 2018 2021 This ___ day of _______, 2018 2021 By: By: Name: Name: Title (if any): Title: Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I______________________ am the ___________________________ of ___________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Subscription Securities Purchase Agreement and to purchase and hold the Notes and SharesWarrants, and certify further that the Subscription Securities Purchase Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.

Address Information. For individual subscribers this address should be the PurchaserSubscriber’s primary legal residence. For entities other than individual subscribers, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. 170 Xxxxxxxxx Xxxxxx Xxxxx Legal Address Legal Address Lexxx Xxxxxxx Xxxxxxxx, Xxxxxxx, X0X 0X0Xxxxxx City, State, and Zip Code City, State, and Zip Code AGREED AND SUBSCRIBED ACCEPTED This ___ day of _________, 2018 This ___ day of _______, 2018 By: By: Name: Iax Xxxxxxxx Name: Paxxxxx Xxxxxxxx Title (if any): Title: Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I, ______________________ , am the ___________________________ of ___________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Subscription Securities Purchase Agreement and to purchase and hold the Notes Note and SharesWarrants, and certify further that the Subscription Securities Purchase Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.